Establishing best practices for structured NSQIP review.

INTRODUCTION: We describe an institutional program (INR- Interval NSQIP Review), to augment NSQIP utility through structured, multidisciplinary review of surgical outcomes in order to create near 'real-time' adverse event (AE) monitoring and improve surgeon awareness. METHODS: INR is a monthly meeting of quality analysts, surgeons and nursing leadership initiated to validate AE with NSQIP criteria, review data in real-time, and perform in-depth case analyses. Occurrence classification concerns were referred for national NSQIP review. Monthly reports were distributed to surgeons with AE rates and case-specific details. RESULTS: Since implementation, 377/3,026 AE underwent in-depth review. Of those, 7 occurrences were referred for clarification by central NSQIP review. Overall 37 (1.2%) were not consistent with NSQIP-defined AE after INR. Time from occurrence to surgeon review decreased by 223 days (296 vs. 73 days, p = 0.006). DISCUSSION: Structured monthly institutional review of AE prior to submission can create greater transparency and confidence of NSQIP data, reduce time from occurrence to surgeon recognition, and improve stakeholder understanding of AE definitions. This approach can be tailored to institutional needs and should be evaluated for downstream improvement in patient outcomes.

Utilizing technology to improve intraoperative family communication.

PURPOSE: To create and assess satisfaction with an electronic-medical-record (EMR) integrated communication system designed to optimize perioperative communication with families. METHODS: We built a tool in the EMR's intraoperative nursing navigation screen for sending customized or standardized text pages to families in English or Spanish. Preoperatively, families were given text pagers with instructions and a hospital map to facilitate leaving the waiting area. After 6 months, Press-Ganey™ data and internal surveys from randomly selected families, and all nurses and surgeons were analyzed for satisfaction and effectiveness. RESULTS: Press-Ganey™ data demonstrated 30% improvement in patient satisfaction (p < 0.05). Among families, > 90% indicated pagers were easy to use and provided the desired information during surgery. Of nurses, >90% found the system easy to use and believed it improved families' experience. All surgeons reported improved intraoperative communication and ease of finding families postoperatively. CONCLUSION: Perioperative family communication via EMR-integrated text improves efficiency and family, nurse, and surgeon satisfaction.